Conformal Radiotherapy as a Bridge to Liver Transplantation for Hepatocellular Carcinoma: Is It Safe?

Mohkam, Kayvan; Golse, Nicolas; Bonal, M.; Ledochowski, Stanislas; Rode, Agnès; Selmaji, I.; Merle, Philippe; Ducerf, C.; Mornex, F.; Mabrut, Jean‐Yves

doi:10.2217/fon-2016-0083

Cited by 8 publications

(10 citation statements)

References 34 publications

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“…After careful selection, some patients with a score beyond 2 may also be considered for LT using rescue allocation allografts [9]. The LT procedure has been described elsewhere [10,11].…”

Section: Methodsmentioning

confidence: 99%

External validation of the French alpha‐fetoprotein model for hepatocellular carcinoma liver transplantation in a recent unicentric cohort – a retrospective study

et al. 2021

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Summary Prognostic models of liver transplantation (LT) for hepatocellular carcinoma (HCC) mainly derive from LT cohorts with numerous hepatitis C virus (HCV) patients. The AFP model, which is currently used in France to select LT candidates, was derived from a cohort of LT performed between 1988 and 2001, including a majority of HCV‐positive recipients. The emergence of new direct‐acting antiviral therapies and subsequent decrease of HCV incidence may change the generalizability of such models. We performed an external validation of the AFP model in a cohort of recipients transplanted between 2005 and 2018. Although multivariable analysis identified all three model’s factors (AFP level, largest tumor size, number of nodules) as predictors of tumor recurrence, the AFP model showed poor discrimination and calibration in the present cohort. This poor performance could be related to significant differences between the derivation and the present cohort in terms of etiology, severity of underlying liver disease, tumor burden and differentiation, and use of neoadjuvant treatments. The present findings suggest that the decline of HCV‐induced HCC among LT candidates may compromise the generalizability of the AFP model in more recent LT cohorts. Further studies are required for updating or building more robust prognostic models.

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“…After careful selection, some patients with a score beyond 2 may also be considered for LT using rescue allocation allografts [9]. The LT procedure has been described elsewhere [10,11].…”

Section: Methodsmentioning

confidence: 99%

External validation of the French alpha‐fetoprotein model for hepatocellular carcinoma liver transplantation in a recent unicentric cohort – a retrospective study

et al. 2021

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“…3). [13][14][15] Given that there is no evidence to suggest that MWA, RFA or TACE leads to central fibrosis or has a clinical impact on LT, we support the use of SBRT when the target is not amenable to these modalities. Thermal ablation (MWA or RFA) is recommended for lesions less than 30 mm in diameter in a suitable anatomical location.…”

Section: Discussionmentioning

confidence: 95%

“…5,[16][17][18][19][20] Another study employed 3D conformal radiotherapy prior to LT and reported major complications as a result of fibrosis around the central structures and diaphragm. 13 Whilst it is important to note that SBRT delivers far more conformal dosimetry compared to 3D conformal radiotherapy, this finding suggests that it is important to minimise dose to these structures. The presence of hilar and pericaval fibrosis at the time of LT appeared to increase the operating time.…”

Section: Discussionmentioning

confidence: 99%

“…They also described increased anastomotic complications and radiotherapy-related bile duct necrosis. 13 In that study, radiotherapy was delivered using conformal technique, which is not considered SBRT. Guarneri and colleagues observed intraoperative complications in three of eight patients, notably retrohepatic and inferior vena cava sclerosis, although there were no attributable postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

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Refining stereotactic body radiation therapy as a bridge to transplantation for hepatocellular carcinoma: An institutional experience

et al. 2023

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Background: Stereotactic body radiotherapy (SBRT) has been established as a safe and effective treatment for hepatocellular carcinoma (HCC). Currently, there are no consensus guidelines to advise optimal patient selection and radiotherapy planning parameters to minimise the risk of surgical and medical complications after liver transplant (LT) in patients who have had prior SBRT for HCC, whilst optimising treatment benefit. Methods: We performed a retrospective analysis of all adult patients who received liver SBRT as a bridge to LT at a tertiary institution between 2017 and 2019. Results: Nine patients received SBRT as bridging therapy to LT. HCC location varied from peripheral to central/hilar regions and HCC diameter was 13-54 mm. Median time between SBRT and LT was 141 days (range 27-461 days). Median operating time was 360 min (range 270-480 min). Four patients (44%) had visible SBRT reaction or fibrosis at the time of LT. SBRT reaction resulted in clinical impact in one patient (11%) only, where vascular clamping of the IVC was required for 10 min. Conclusion: SBRT is a safe and effective treatment for HCC enabling patients to remain within LT criteria, even for lesions not amenable to other more conventional bridging therapies. We describe a preliminary decision pathway to guide the optimal use of SBRT as a bridge to LT developed in our institution.

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“…Previously, radiotherapy has played a small role in the treatment of HCC because of the poor radiation tolerance of normal liver tissue and adjacent organs. With advancements in radiotherapy technologies, it is now possible to safely deliver a higher radiation dose to the tumor, especially with the application of stereotactic body radiation therapy in recent years (Mohkam et al 2016;Baumann et al 2018;Choi and Seong 2018;Park et al 2020). However, side effects, such as radiation-induced liver disease (RILD), have been observed in patients undergoing radiotherapy (Song et al 2017;Huang et al 2018); the mean hepatic dose in patients with RILD was higher than that in those without RILD.…”

Section: Introductionmentioning

confidence: 99%

MiR-122 radiosensitize hepatocellular carcinoma cells by suppressing cyclin G1

Wang

et al. 2021

International Journal of Radiation Biology

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Purpose: Emerging evidence has shown that radiotherapy is an effective treatment for hepatocellular carcinoma (HCC), Micro(mi)RNAs are involved in regulating radiosensitivity in many cancers. MiR-122 accounts for approximately 70% of all cloned miRNAs in the liver, but there are few reports about whether it is involved in regulating of radiosensitivity in HCC cells. Materials and Methods: HCC cells (HepG2 and Huh7) overexpressing miR-122 were constructed by transfecting them with lentiviral-miR-122. Then, their proliferation ability was analyzed by the MTT, and colony formation assays and a xenograft tumor model was used to detect their radiosensitivity. The expression of cyclin G1 mRNA and protein was detected by the quantitative realtime polymerase chain reaction and western blotting, respectively. Results: Overexpression of miR-122 inhibited the proliferation of, and radiosensitized HCC cells. Cyclin G1 mRNA and protein level were suppressed in HepG2 tumors overexpression miR-122. Conclusion: MiR-122 may be useful as a potential radiosensitizer for HCC, and its mechanism is related to the regulation of cyclin G1.

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Conformal Radiotherapy as a Bridge to Liver Transplantation for Hepatocellular Carcinoma: Is It Safe?

Abstract: CRT for HCC provides satisfactory histological response but may compromise OLT safety.

Cited by 8 publications

References 34 publications

External validation of the French alpha‐fetoprotein model for hepatocellular carcinoma liver transplantation in a recent unicentric cohort – a retrospective study

External validation of the French alpha‐fetoprotein model for hepatocellular carcinoma liver transplantation in a recent unicentric cohort – a retrospective study

Refining stereotactic body radiation therapy as a bridge to transplantation for hepatocellular carcinoma: An institutional experience

MiR-122 radiosensitize hepatocellular carcinoma cells by suppressing cyclin G1

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